Hypodermic needles are widely used in the health care industry. It has been estimated that there are over five billion needles used each year in the U.S. alone. Needles are used for a wide variety of purposes. Needles are used for drawing blood from a patient for analysis; giving injections or immunizations; removing fluid from the body for treatment, such as from the thoracic cavity, peritoneal cavity, a joint, or the chest; obtaining signal fluid for analysis; drawing medication into a syringe in preparation for administering the medication to a patient; taking samples of amniotic fluid for intrauterine studies of a fetus; etc.
The training, care and dexterity of the personnel who handle needles vary considerably. The person handling the needle may be a medical technician, a nurse, a doctor, or a patient administering insulin or other drug to himself. The training in proper handling of needles varies considerably from individual to individual, as does the awareness of the risk of a needle stick with a contaminated needle. The care taken to avoid an accidental needle stick to themselves or another person may vary considerably. An individual's manual dexterity will also vary widely from person to person and may change with the individual, depending on the situation. For example, during an emergency situation, a person's hand may be less steady or the person may be distracted while handling a needle. In addition to the risks to the technicians, nurses, patients, and doctors handling the needle, there are also risks to the janitorial staff who clean medical clinics and hospitals.
Accidental needle sticks to an individual occur in a variety of situations. One of the most common is when the user is recapping the needle with the cover after removing the needle from the patient. When recapping the needle, the user generally holds the syringe having the needle in one hand while holding the cover in the other hand and advances the cover towards the needle tip until the needle tip is covered by the cover. The risk is that, as the cover approaches the needle, a slight misalignment or unexpected movement of either the needle or the cover will cause the fingers or hand holding the cover to be punctured by the needle. Even a person having a steady hand may stick himself if inadvertently bumped or in a situation where the patient is uncooperative. Needle sticks may also occur when using the needle to inject blood or other fluid removed from a patient into a test tube for later testing, to draw medicine from a bottle, to insert medication into an intravenous line for an injection, or other assorted uses of the needle.
The problem posed by being stuck with a needle is the possibility that the needle is contaminated. Blood is well known to carry a variety of infectious agents which can be spread by a needle stick from a needle which has just been used in a person having an infection. These infections include: HIV (the agent of AIDS); Hepatitis B (serum hepatitis); Hepatitis Non A Non B; Delta Hepatitis; Cytomegalovirus (CMV); and a variety of other infectious agents. Unfortunately, only a small stick with a contaminated needle may be sufficient to transmit many types of infection.
The magnitude of the risk is somewhat difficult to determine. In many hospitals, all accidental needle sticks are requested to be reported. However, personnel often tend to under-report accidental needle sticks because they are too busy, are too embarrassed to report having stuck themselves, a patient or a fellow health worker, or forget to report due to the emergency of the situation at the time. Some studies estimate that there are as many as 120 or 160 accidental needle sticks per year per 1000 members of a hospital staff. It has been estimated that there are in excess of 80,000 accidental needle sticks each year in the U.S.
One solution to reduce the risk of accidental needle sticks is to place a Sharp's container in each room of a medical unit. A Sharp's container is a puncture-proof container into which the needle is placed which encloses the needle entirely and may also break it off. The Sharp's container prevents the needle from being removed after it is placed therein. The container is then disposed of in its entirety. When a Sharp's container is present in the room, the user is cautioned to not recap the needle at any time. This is because it is felt that the greatest risk of an accidental needle stick occurs when recapping a contaminated needle, as previously explained herein. Rather, the user is instructed to simply dispose of the exposed needle into the Sharp's container.
Unfortunately, this solution has numerous disadvantages and does not prevent numerous needle sticks. A Sharp's container must be located in each individual medical unit or room and must be close to the place where the needles are being used. Otherwise, the needle user must move with the uncovered needle from his present position near the patient to the Sharp's container. This creates significant additional risks.
Even with properly located Sharp's containers, placing the contaminated needle in a Sharp's container is not immediately possible in many situations. The needle user may be caring for the patient from whom the needle was just withdrawn by applying pressure with one hand to the point where the needle was removed to prevent bleeding. In the event the patient is a young person or a person particularly disturbed by the sight of a needle being placed in or removed from his body, additional risk occurs because of the possibility of unexpected movement of the patient. If the needle has been used to aid in the placement of an intravenous ("IV") tube, the user must do many things at once which limit the opportunities to dispose of the needle. For example, blood may be coming back up the catheter which was inserted over the needle. If the user leaves the patient, the blood may leak out of the catheter or the IV may come out of the patient's arm. Often, the user places the contaminated needle on a table next to the patient while completing the medical procedure and further caring for the patient. The contaminated needle is disposed of when he has time. This leaves an uncovered, contaminated needle in an environment where the type of activity is occurring which may result in accidental needle sticks. The Sharp's box can also be full, thereby presenting a problem with needle disposal.
A different set of problems are present when it is necessary for the needle to be reused. For example, blood or other fluid is often drawn from a patient for use in diagnostic tests. In this procedure, a needle attached to a syringe is placed into the patient's body and the syringe is filled with the body fluid to be tested. The needle is removed from the patient's body with the syringe full of the extracted fluid to be tested. The needle is now contaminated and the syringe is full of contaminated fluid. Frequently, numerous tests are to be performed which require a specific amount of the body fluid to be placed in different test tubes. The hospital staff member, after removing the needle from the person's body, sticks the needle attached to the syringe having the fluid therein through a rubber covering over a test tube and places the required amount of fluid into the test tube. Movement similar to that used in placing the cover of the needle is involved, with similar risks. The needle is then removed from this test tube and the same needle is used to place a fluid sample into a second test tube. Numerous test tubes may have varying amounts of the body fluid placed therein by the hospital staff member immediately after having drawn the fluid from the patient. This presents numerous opportunities for the hospital staff member to accidentally stick himself with the contaminated needle. A similar problem occurs when connecting one IV line to a second IV using a needle to make the connection or when drawing medicine from a bottle. For those procedures which require the same needle to be used repeatedly after it has been removed from a patient's body, a Sharp's container is not a possible solution until after the high risk, repeated uses of the needle have been completed.